ERAP Application

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Answer all of the following questions to qualify for assistance

Basic Information (fields with * are required)

Primary Account Holder's Last Name *

Primary Account Holder's First Name *

M.I

Utility Account Number *

Last 4 of SSN *

Type of Utility Account *

Service Address *

Unit

City *

State *

Zip *

E-mail *

Phone Number *

How did you hear about ERAP? *

Income Verification (fields with * are required)

How has your income been impacted by COVID-19? *

Are you currently receiving unemployment benefits? *

Date of job loss *

Gross Monthly Household Income Prior to Covid-19? *

Gross Monthly Household Income During Covid-19? *

Applicant's Signature (fields with * are required)

1. I hereby authorize Riverside Public Utilities (RPU) to:

Examine all employment, income, utility and other records pertinent to my application for energy assistance.
Make direct payment to my Riverside Public Utilities bill.
Provide valid and recent documents supporting your claim

2. I certify that I amqualified for Emergency Recovery Utility Assistance.

3. I certify that I am solely or jointly responsible for payment of the utilities for this address.

4. I certify under penalty of perjury that all information herein is true and correct to the best of my knowledge and that I have read the Privacy Notification.

Please type in your full name *

Please confirm today's date *

Documents that are not accepted:

Paycheck stubs
Personal statement letters (written or typed)
SSI/SDI income
EDD images that do not show claimant name or claim start date
EDD claims that started prior to 3/1/2020
Text message from employer
Documents for non-account holders

Upload proof of identification (Driver's License, REAL ID, Passport, Military ID) *

Upload employment letter showing reduced income*

Attach additional letters (Optional)

Your application is ready for processing